tbuckley/cabot-search huggingface dataset:
Abstract 9551: Extracorporeal Membrane Oxygenation for Covid-19 in Children: A Systematic Review and Meta-Analysis
Authors: Atsuyuki Watanabe, Jun Yasuhara, Takaharu Karube, Kae Watanabe, Takuro Shirasu, Hisato Takagi, Hisato Takagi, Naokata Sumitomo, Simon Lee, Toshiki Kuno
Journal: Circulation (2022)

Introduction: In the wake of the COVID-19 pandemic, extracorporeal membrane oxygenation (ECMO) has been widely used to treat severe acute respiratory distress syndrome (ARDS) in adults. However, the indications, complications, and outcomes of ECMO in children with COVID-19 remain unelucidated. We conducted a systematic review and meta-analysis to investigate the characteristics and outcomes of ECMO use in children with COVID-19. Methods: PubMed and EMBASE databases were searched in March 2022 without language restrictions, and studies involving children (aged≤18) with COVID-19 who received ECMO were included. Two investigators extracted data and assessed the risk of bias independently. Mortality, successful weaning rate, and complications related to ECMO were synthesized by a one-group meta-analysis using a random-effect model. Results: We included 18 observational studies, 4 case series, and 22 case reports encompassing 110 children with COVID-19 requiring ECMO. The median age was 8 years (range: 10 days to 18 years), and the median body mass index was 21.4 kg/m 2 (range: 12.3-56.0). The most common comorbidities were obesity (11% [7/63]) and congenital heart diseases (11% [7/63]), while 48% (30/63) were previously healthy. The major indications were multisystem inflammatory syndrome in children (52% [47/90]) and ARDS (40% [36/90]). Seventy-one percent (56/79) received venoarterial-ECMO. The median ECMO runtime was 7 days (range: 3-71). The mortality rate was 26.6% (95% confidence interval [CI] 15.9-40.9), and the successful weaning rate was 77.0% (95% CI 55.4-90.1). ECMO-related complications, including stroke, acute kidney injury, pulmonary edema, and thromboembolism, were seen in 37.0% (95% CI 23.1-53.5). Conclusions: This meta-analysis demonstrated relatively favorable outcomes of ECMO for COVID-19 in children. Our findings will contribute to establishing the evidence of ECMO and serve as a guide to managing children with severe COVID-19.
Abstract 9792: Persistent Hypochloremia is Associated With Adverse Prognosis in Patients With Heart Failure
Authors: Yuji Nozaki, Akiomi Yoshihisa, Yu Sato, Himika Ohara, Yukiko Sugawara, Satoshi Abe, Tomofumi Misaka, Takamasa Sato, Masayoshi Oikawa, ATSUSHI KOBAYASHI, Takayoshi Yamaki, Kazuhiko Nakazato, Yasuchika Takeishi
Journal: Circulation (2022)

Introduction: Prognostic impact of persistent hypochloremia has been unclear in patients with heart failure (HF). Methods &amp; Results: We recruited data of patients who were hospitalized for HF at least twice repetitively at our hospital from 2010 to 2021 (n = 309). Patients were divided into four groups based on the absence/presence of hypochloremia (&lt; 98 mmoL/L) at discharge from 1st and 2nd hospitalization: Group A (patients without hypochloremia at 1st and 2nd hospitalization, n = 238), Group B (those with hypochloremia at 1st hospitalization and without hypochloremia at 2nd hospitalization, n = 25), Group C (those without hypochloremia at 1st hospitalization and with hypochloremia at 2nd hospitalization, n = 32), and Group D (those with hypochloremia at 1st and 2nd hospitalization, persistent hypochloremia, n = 14). We compared patients’ characteristics and prognosis after 2nd discharge. Group D showed highest age (Group D vs. Group A, B, and C; 75.5, 73.0, 63.0, and 74.5 years, respectively, P = 0.037) and highest prevalence of atrial fibrillation (92.9%, 46.6%, 44.0%, and 50.0%, P = 0.009) among the four groups. Levels of B-type natriuretic peptide were comparable among the four groups. In the Kaplan-Meier analysis, all-cause mortality and cardiac mortality were highest in the Group D compared to other groups (Figure, log-rank P &lt; 0.001). The multivariable Cox proportional hazard analysis revealed that persistent hypochloremia was independently associated with all-cause mortality (hazard ratio 3.235, P &lt; 0.001) and cardiac mortality (hazard ratio 3.069, P = 0.004). Conclusions: Persistent hypochloremia predicts poor prognosis in patients with HF.
Abstract 9276: Subcutaneous and Transvenous Defibrillator in Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Weijia Wang, Alessio Gasperetti, Samuel Sears, Crystal Tichnell, Brittney Murray, Harikrishna S Tandri, Cynthia James, Hugh G Calkins
Journal: Circulation (2022)

Introduction: There is limited evidence guiding the selection between subcutaneous and transvenous ICD in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) at risk for sudden death.Hypothesis: We aimed to compare clinical and quality of life outcomes between transvenous and subcutaneous implantable defibrillators (ICD) among patients with ARVC. Methods: Patients with subcutaneous ICD (n=57) were matched to patients with transvenous ICD (n=88) based on sex, proband status, primary prevention or secondary prevention, monomorphic ventricular tachycardia before implant, and year of implant. Appropriate therapy for ventricular arrhythmia, inappropriate shocks, and complications were compared. Quality of life surveys were conducted annually. Results: The matched cohort (median age of 35 years, 43% male, 78% proband, and 37% secondary prevention device) were prospectively followed for 5.1 (+/-2.5) years. No significant difference was observed in the rate of appropriate ICD shocks. The subcutaneous group had more inappropriate shocks (23% versus 10%) and fewer procedure related complications (4% versus 14%) than the transvenous group (p &lt;0.05). The association between ICD type and the composite of inappropriate shock and complication was not statistically significant (adjusted hazard ratio 1.43 subcutaneous vs. transvenous, 95% confidence interval 0.72-2.84). Subcutaneous ICD was associated with more body image concerns and range of motion than transvenous ICD (p &lt;0.05). Conclusions: In patients with ARVC receiving an ICD, the risk of inappropriate shocks from subcutaneous ICD should be balanced against the significant vascular complication risk from transvenous ICD. Patients with subcutaneous ICD had more concerns for body image and range of motion.
Abstract 323: Global Prevalence Of Cardiopulmonary Resuscitation And Automated External Defibrillator Training: A Systematic Review And Meta-analysis
Authors: Joel Xin Rui Ting, Trina Ng, Sean Eng, Jun Wei Yeo, Chermaine Bok, Joyce Yeon Kong, Willem Stassen, Lin Zhang, Marcus Ong Eng Hock, Audrey L Blewer, Girvan Tay, Andrew Fu Wah Ho
Journal: Circulation (2022)

Global prevalence of cardiopulmonary resuscitation and automated external defibrillator training: a systematic review and meta-analysis Aim: Sudden cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED). The global prevalence and distribution of laypersons trained in these skills are poorly understood. We aimed to estimate the global prevalence of CPR and AED training, and identify their determinants. Method: We searched Medline, Embase and Cochrane Library from inception to October 24th, 2021, for cross-sectional studies reporting the prevalence of CPR or AED training from representative samples of laypersons. Prevalences were pooled using random effects models. We examined varying definitions of being identified as CPR-trained, namely CPR-V (valid training within 2-years), CPR-E (ever been trained). Subgroup analysis and meta-regression were used to examine determinants of interest. Results: 28 studies were included, representing 53,397 laypersons. Among national studies, the prevalence of CPR-V training was 10.02% (95% CI 6.60 to 14.05), prevalence of CPR-E training was 39.64% (95%CI 29.11 to 50.67), and prevalence of AED training was 15.70% (95% CI 10.17 to 22.18). Subgroup analysis revealed differences in prevalences between continents,with prevalence highest in Oceania and lowest in Asia (p&lt;0.01). Meta-regression showed a positive correlation between a country’s income and CPR-E training prevalence (​​ p=0.0325). Comparative meta-analysis showed that the prevalence of CPR-E training was higher among the employed (p&lt;0.00001), and the more highly educated (p&lt;0.00001). Conclusion: Large regional variation exists in the data availability, and prevalence of CPR and AED training amongst laypersons. Socioeconomic status correlated with prevalence of CPR training and regional disparities were apparent between continents. As such, community bystander training should be promoted, particularly in Asia and low-income regions, while data availability should be encouraged from under-represented regions.
Abstract 9771: Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008-2018
Authors: Nicholas Chiu, Leonard Chiu, Rahul Aggarwal, Inbar Raber, Deepak L Bhatt, Ken J Mukamal
Journal: Circulation (2022)

Introduction: Hypertension control has worsened in recent years, yet trends for appropriate blood pressure intensification practices for older adults is unknown. Hypothesis: We determine the proportion of ambulatory visits where older adults with hypertension were appropriately intensified on anti-hypertensives over the past decade. We hypothesize that treatment intensification may not have improved over time. Methods: Data from National Ambulatory Medical Care Survey (NAMCS, 2008-2018) were used. NAMCS is a nationally representative sample of ambulatory medical visits. Adults ages 60 years or older were included. Appropriate antihypertensive intensification was defined as the addition of an antihypertensive for a blood pressure reading above target. We examined appropriate intensification by blood pressure targets set by the ACC/AHA, the ESC, and the ACP/AAFP guidelines for older adults. Further, we defined an additional all-inclusive criterion meeting all three guidelines. Results: From 2008-2018, appropriate treatment intensification by ACC/AHA guidelines occurred at 11.1% (95% CI:9.8-12.5%) of visits, decreasing from 13.6% (95% CI:15.6-28.7%) of visits in 2008-2009 to 10.4% (95% CI:10.9-26.4%) in 2015-2018. Appropriate intensification by ESC occurred at 14.2% (12.1-16.6%) of visits over 2008-2018, decreasing from 16.9% (95% CI:13.5-21.0%) in 2008-2009 to 12.5% (95% CI:7.4-20.3%) from 2015-2018. Appropriate intensification by AAFP/ACP occurred at 18.9% (16.2-22.0%) of visits over 2008-2018, decreasing from 24.7% (95% CI:20.2-29.0%) in 2008-2009 to 14.9% (95% CI:9.0-23.7%) from 2015-2018. By all-inclusive criteria, intensification trended towards worsening with time: odds ratio: 0.93 (95% CI:0.87-1.00; p=0.07). Conclusions: Appropriate treatment intensification for older adults with hypertension in the US was suboptimal over the past decade despite growing trial evidence showing beneficial effects for intensive blood-pressure control in older adults. Strategies to mitigate therapeutic inertia are needed, and clinical practices should make concerted efforts to improve appropriate treatment intensification in older adults.
Abstract 9383: Full versus Limited Transesophageal Echocardiography at the Time of Cardioversion for Atrial Fibrillation
Authors: Khan O Mohammad, Steven A Alexander
Journal: Circulation (2022)

Introduction: Transesophageal echocardiography (TEE) is frequently used to evaluate the left atrial appendage (LAA) prior to direct-current cardioversion (DCC) for atrial fibrillation (AF). Clinically relevant findings may be discovered prior to DCC. The optimal TEE study protocol at the time of DCC is unknown. Methods: One-hundred and fifty patients undergoing TEE-guided DCC for AF were retrospectively analyzed. Patients were separated into two groups based on the type of study performed. Comprehensive studies were defined as full TEEs (F-TEE). Studies focused on the LAA were defined as limited TEEs (L-TEE). The TEE findings between both groups were compared. Results: Among 150 patients included in the study (mean age, 66.9 ± 14.3 years; 31% female), 81 (54%) had an F-TEE and 69 (46%) had an L-TEE. Abnormal findings were significantly higher in the F-TEE group compared with the L-TEE group (76.5% versus 47.8%; P&lt;0.005). In patients with a prior study, a new finding was observed more often in the F-TEE versus L-TEE group (56.5% versus 22.0%; P&lt;0.005). In patients with a prior study performed within the previous 2 months, a new finding was observed in 55.3% versus 28.1% (P=0.022). F-TEE took longer to perform compared to L-TEE (7.9 ± 3.3 versus 4.3 ± 3.8 minutes; P&lt;0.005). Conclusions: Among patients undergoing TEE-guided DCC for AF, F-TEE reported significantly more cardiovascular pathology when compared to L-TEE. Among patients with prior echocardiographic studies, F-TEE reported significantly more new findings, regardless of whether the prior study was recent or remote. We believe our findings offer a convincing argument to adopt an F-TEE protocol for studies performed pre-DCC.
Abstract 9458: Ptfv1 Size is Associated With Development of Atrial Fibrillation in an Obstructive Sleep Apnea Cohort
Authors: Zachary Falk, Omowunmi Adedeji, Maximillian Lee, Marco Mercader
Journal: Circulation (2022)

Introduction: This study aimed to investigate the interaction between obstructive sleep apnea (OSA) and development of atrial fibrillation (AF) by analyzing P-wave terminal force in V1 (PTFV1), an ECG parameter related to left atrial (LA) abnormalities. ECG-defined LA abnormalities, indicative of some structural or electrical remodeling, is suggestive of a predisposition to AF. Hypothesis: In patients with OSA, the odds of having an ECG with an abnormal PTFV1 value (as defined by &gt; -4000 μV*ms) are higher in those who developed AF, compared with controls. Methods: A retrospective review was conducted in patients who underwent a polysomnography (PSG). Inclusion criteria for data collection were completion of PSG, diagnosis of OSA, and record of ECG. Manual measurements which were done using the EP Calipers software (EP Studios, Inc.) to standardize our approach. Results: 62 patients with AF and 377 control patients without AF were included for analysis. Baseline characteristics were similar between the two subgroups (relevant parameters are tabulated in table 1). PTFV1 was significantly higher in the AF subgroup (-4593.01 μV*ms) vs the control subgroup of -1906.2 μV*ms (p &lt;0.001). Of the 62 patients who developed AF, 27 were noted to have an abnormal PTFV1 as defined as a value &gt;[-4,000 μV*ms]. The odds ratio was calculated to be 3.32 (CI 1.89-5.84). Conclusions: We found that in a cohort of patients with OSA, the odds of having an ECG with an abnormal PTFV1 value (as defined by &gt; -4000 μV*ms) were higher in those who developed AF, compared with those who did not. This value is comparable to previous odds ratios calculated in the general population, but appears elevated in our cohort, suggesting a heightened risk in individuals with OSA irrespective of OSA severity (as noted by AHI), arousal index, or CPAP usage. Future research should expand on these preliminary results to include a larger sample size and more robust patient demographic data.
Abstract 9459: Bariatric Surgery Improves Mortality in Patients With Heart Failure
Authors: Andres M Cordova, Ana M Morales Mejia, Debanik Chaudhuri
Journal: Circulation (2022)

Introduction: Bariatric surgery has been associated with decreased adverse cardiovascular outcomes. There is a paucity of data regarding long-term outcomes in patients with heart failure who underwent bariatric surgery. Hypothesis: Bariatric surgery is associated with better long-term outcomes in patients with heart failure and BMI≥40. Methods: Using ICD-10 codes, we identified patients with heart failure and BMI≥40 from 2016 to 2021 by using the TriNetx diamond network which includes data from ambulatory and primary care electronic medical records, medical claims from claims clearinghouses, and patient medication data from pharmacy claims around the USA. The patient population was divided in 2 groups, those who underwent a bariatric surgery procedure versus those who did not. Subgroup analysis of patients with systolic and diastolic heart failure was also performed. Propensity score matching was used to equilibrate for approximately 90 variables. The outcomes were measured from 3 months up to 5 years after the index event. Results: A total of 2,896 patients were included in each cohort, 63% were females. Patients with heart failure and BMI ≥ 40 kg/m2 that underwent bariatric surgery had approximately 67% lower likelihood of mortality (OR 0.336, P&lt;0.0001), 50% lower incidence of atrial fibrillation (OR 0.504, P&lt;0.0001), 45% less ventricular tachycardia (OR0.556, P0.0014), 43% less AMI (OR 0.578, P 0.0148), and 30% less cerebral ischemia (OR 0.708, P0.043). On subgroup analysis, similar outcomes were seen in patients with systolic heart failure except for cerebral ischemia which did not have a significant association. In patients with diastolic heart failure, only mortality and atrial fibrillation had lower incidences after bariatric surgery. Conclusions: Bariatric surgery is associated with decreased mortality and cardiovascular outcomes in patients with heart failure and BMI≥40. Prospective and/or randomized studies are required to prove these results.
Abstract 9371: Effectiveness of Endovascular Aneurysm Repair With Inferior Mesenteric Artery Embolization From Mid-Term Outcome of a Randomized Controlled Trial
Authors: Yuriko Takeuchi, Noriyasu Morikage, Ryo Ohtsuka, Soichi Ike, Takahiro Mizoguchi, Makoto Samura, Takasuke Harada, Kotaro Suehiro, KIMIKAZU HAMANO
Journal: Circulation (2022)

Introduction: Adequate management of type II endoleak (T2EL) has been widely discussed, and inferior mesenteric artery (IMA) embolization before endovascular aneurysm repair (EVAR) has been reported to reduce the T2EL. However, there have been no randomized controlled trials (RCT) confirming the efficacy. Thus, this study aimed to evaluate the effect of IMA embolization during EVAR in patients at high risk of T2EL in an RCT. Methods: This study included patients scheduled for elective EVAR between September 2014 and March 2018. Patients at high risk of T2EL (IMA patency with IMA ≥ 3 mm, LAs ≥ 2 mm, or an aortoiliac-type aneurysm) were prospectively randomized to receive EVAR with or without IMA embolization. The primary endpoint was T2EL occurrence during follow-up. The secondary endpoints were aneurysmal sac changes, adverse events from IMA embolization, and reintervention rate due to T2EL. Results: A total of 106 patients were randomized to the embolization group (group A, n = 53) or the nonembolization group (group B, n = 53). The technical success rate of IMA embolization was 88.7%, and no complications related to IMA embolization were observed. During the mean follow-up period—50.2 ± 21.9 months in group A and 52.9 ± 23.1 months in group B—the incidence of T2EL was significantly lower in the embolization group (23.9% in group A vs. 53.8% in group B; P &lt; 0.0001). Sac diameter changes, the incidence of aneurysmal sac growth (≥5 mm) related to T2EL, and freedom from sac enlargement (≥5 mm) related to T2EL at 5 years were –6.5 ± 8.9 mm vs. –1.1 ± 13.1 mm, 6.5% vs. 25.0%, and 97.5% vs. 72.0% in groups A and B, respectively (P = 0.015; P = 0.025; P = 0.018), which show that both shrinkage of aneurysm and freedom from sac enlargement are significantly higher in group A. Although no significant difference was observed in the reintervention rate due to T2EL (0% in group A vs. 2% in group B; P = 0.344), a significant difference in sac enlargement (≥10 mm) related to T2EL was observed (0% in group A vs. 13.5% in group B; P = 0.010), suggesting that reintervention would need to be considered. Conclusions: The results demonstrated the effectiveness of IMA embolization during EVAR in high-risk patients for the prevention of T2EL, which is suggested for avoiding aneurysmal sac enlargement related to T2EL.
Abstract 9252: Risk for Incident Coronary Heart Disease Associated With High Lipoprotein(a) by Levels of Factor VIII and High-Sensitivity C-Reactive Protein
Authors: Lisandro D Colantonio, Sascha N Goonewardena, Zhixin Wang, Elizabeth A Jackson, Michael E Farkouh, Mei Li, Waqas Malick, Shia Kent, J G Lopez, Paul Muntner, Vera A Bittner, Robert S Rosenson
Journal: Circulation (2022)

Introduction: Both coagulation and inflammation may contribute to the higher risk for coronary heart disease (CHD) associated with high lipoprotein(a) [Lp(a)]. The association of Lp(a) with CHD is stronger in individuals with high versus low high-sensitivity C-reactive protein (hsCRP), a marker of inflammation. It is unclear if coagulation Factor VIII also modifies the association of Lp(a) with CHD independently of hsCRP. Hypothesis: Lp(a) is associated with incident CHD in adults with high Factor VIII after adjustment for hsCRP but not among those with low Factor VIII. Methods: We analyzed data from 6,495 adults 45 to 84 years of age without a history of cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis (MESA). Lp(a) mass concentration, Factor VIII antigen, and hsCRP were measured using blood collected at baseline (2000-2002). Lp(a), Factor VIII and hsCRP were categorized as high or low (≥75th or &lt;75th percentile of the distribution). Participants were followed for incident CHD through 2015 (median follow-up 14 years). Results: The mean age of participants was 62 years and 47% were male. After log-transformation, the Pearson’s correlation between Factor VIII and hsCRP was 0.15 (p-value &lt;0.001). High Lp(a) was associated with an increased risk for incident CHD in participants with high Factor VIII and high hsCRP, separately, but not among those with low Factor VIII or low hsCRP (Table). The adjusted hazard ratio (95%CI) for CHD associated with high Lp(a) was 1.09 (0.77, 1.53) in participants with low Factor VIII and low hsCRP, 1.49 (0.84, 2.67) in those with low Factor VIII and high hsCRP, 1.54 (0.92, 2.59) in those with high Factor VIII and low hsCRP, and 3.84 (1.85, 7.97) in those with high Factor VIII and high hsCRP (p-value comparing hazard ratios 0.02). Conclusions: High Lp(a) is a risk factor for incident CHD in adults with high Factor VIII or hsCRP. The activation of either the inflammation or coagulation pathway may modify the association of Lp(a) with CHD.